B. Völker

Facial pigmentation following therapy with terbinafine

A 65-year-old patient presented with grey-brownish maculae localized on the face. He had been treated with oral terbinafine due to onychomycosis, and the first spots manifested after 4 weeks of therapy. Other drugs were not taken by the patient, who was otherwise in a healthy condition. Histology showed melanin localized within macrophages in the upper and lower dermis. Cutaneous side effects are well described in patients treated with terbinafine and usually present as urticaria or eczema. Severe reactions may occur in rare cases. Hyperpigmentation has not yet been described as a consequence of oral terbinafine. Grey hyperpigmentation as it occurred in our patient has been described as a side effect of therapy with minocycline, amiodarone, tricyclic antidepressants, or heavy metals. This case report shows that drug-induced hyperpigmentation should also be considered if the patient takes drugs not known for this kind of side effect.

Pigmentierung des Gesichtes unter Therapie mit Terbinafin

A 65-year-old patient presented with grey-brownish maculae localized on the face. He had been treated with oral terbinafine due to onychomycosis, and the first spots manifested after 4 weeks of therapy. Other drugs were not taken by the patient, who was otherwise in a healthy condition. Histology showed melanin localized within macrophages in the upper and lower dermis. Cutaneous side effects are well described in patients treated with terbinafine and usually present as urticaria or eczema. Severe reactions may occur in rare cases. Hyperpigmentation has not yet been described as a consequence of oral terbinafine. Grey hyperpigmentation as it occurred in our patient has been described as a side effect of therapy with minocycline, amiodarone, tricyclic antidepressants, or heavy metals. This case report shows that drug-induced hyperpigmentation should also be considered if the patient takes drugs not known for this kind of side effect.

Das Hand-Fuß-Syndrom als Nebenwirkung der medikamentösen Tumortherapie – Klassifikation und Management

Zusammenfassung Das Hand-Fus-Syndrom (HFS, palmoplantare Erythrodysasthesie, chemotherapieassoziiertes akrales Erythem) ist gekennzeichnet durch schmerzhafte Hautveranderungen, welche betont palmoplantar auftreten. Die Assoziation mit verschiedenen Chemotherapeutika ist seit uber 20 Jahren beschrieben. In den letzten Jahren wurde auch bei gezielten Ansatzen der medikamentosen Tumortherapie, insbesondere durch die Multikinaseinhibitoren (MKI) Sorafenib und Sunitinib, uber das haufige Auftreten eines Hand-Fus-Syndroms berichtet. Im Gegensatz zum HFS unter Chemotherapie zeigt das HFS unter MKI eine andere Verteilung (mit Begrenzung auf Druckpunkte an Handflachen und Fussohlen) und ein anderes klinisches Bild (mit kallusartigen Hyperkeratosen). In dieser Ubersicht werden Gemeinsamkeiten und Unterschiede des HFS in Assoziation mit Chemotherapie und MKI herausgearbeitet sowie derzeitige Empfehlungen zu Therapie und Prophylaxe zusammengefasst. Summary

[Successful symptomatic treatment of epidermodysplasia verruciformis with imiquimod 5% cream].

A 19-year-old patient presented with epidermodysplasia verruciformis (EV). In this genodermatosis, pathogenetic factors such as infection by human papilloma viruses as well as sun exposure are considered responsible for the malignant transformation of EV lesions to skin cancer within decades. So far, several therapeutic strategies have been unsatisfactory. In our case HPV 5b was detected and the associated skin lesions were successfully treated with imiquimod 5% cream.

Erfolgreiche Therapie des Pemphigus foliaceus mit Rituximab

Treatment of autoimmune bullous diseases, especially of the pemphigus diseases, regularly requires the use of immunosuppressive drugs, often with insufficient clinical benefit but considerable side effects. A variety of autoimmune diseases (such as rheumatoid arthritis, lupus erythematosus, pemphigus vulgaris) have been successfully treated with rituximab, a chimeric monoclonal antibody against CD20, leading to a transient depletion of B cells. We report on three patients with pemphigus foliaceus who responded to rituximab after failing multiple other immunosuppressive therapies. We also examine the controversial issue of continuation therapy with rituximab in detail.

Erfolgreiche symptomatische Therapie einer Epidermodysplasia verruciformis mit Imiquimod 5% Creme

A 19-year-old patient presented with epidermodysplasia verruciformis (EV). In this genodermatosis, pathogenetic factors such as infection by human papilloma viruses as well as sun exposure are considered responsible for the malignant transformation of EV lesions to skin cancer within decades. So far, several therapeutic strategies have been unsatisfactory. In our case HPV 5b was detected and the associated skin lesions were successfully treated with imiquimod 5% cream.

Successful treatment of pemphigus foliaceus with rituximab. Report of 3 cases

Treatment of autoimmune bullous diseases, especially of the pemphigus diseases, regularly requires the use of immunosuppressive drugs, often with insufficient clinical benefit but considerable side effects. A variety of autoimmune diseases (such as rheumatoid arthritis, lupus erythematosus, pemphigus vulgaris) have been successfully treated with rituximab, a chimeric monoclonal antibody against CD20, leading to a transient depletion of B cells. We report on three patients with pemphigus foliaceus who responded to rituximab after failing multiple other immunosuppressive therapies. We also examine the controversial issue of continuation therapy with rituximab in detail.

[Intravascular lymphoma: two case reports demonstrating the heterogeneity of the disease].

Intravascular lymphoma (IVL) is a rare subtype of extranodal large-B-cell lymphoma, histologically characterized by accumulation of clonal lymphocytes in small vessels of different organs. Overall survival is usually poor. The clinical manifestations are highly variable, depending on the involved organs. Cutaneous and neurological involvement is frequent; the cutaneous symptoms are heterogeneous with erythema, erythematous papules and plaques, generalized telangiectases and lesions resembling panniculitis or Kaposi sarcoma. IVL may also be limited to the skin; this entity is included the current classifications. We present here two patients with two different variants of IVL. One showed only skin involvement with panniculitis-like induration and responded well to therapy with Rituximab-CHOP (Rituximab plus Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone). The other patient had distinctive cutaneous and neurological symptoms which did not respond to therapy. By means of these two patients, we present the heterogeneity of IVL and discuss current aspects of diagnosis and treatment.

Riesenkeratoakanthom bei einem immunkompetenten Patienten mit Nachweis von HPV 11

A 47-year-old immunocompetent man presented with a nodule on the right side of the upper lip that appeared suddenly and grew rapidly. Histological examination was consistent with the diagnosis of keratoacanthoma which is often associated with immunosuppression. Low-risk HPV type 11 was detected in the PCR analysis. While formerly one often waited for spontaneous regression of keratoacanthomas, today one routinely treats them as a well-differentiated squamous cell carcinoma. Complete surgical excision was not possible in our patient because of the size of the tumor. Radiation with a cumulative dose of 30 Gray (15 sessions of 2 Gray) led to complete remission. In addition to ultraviolet exposure, trauma, genetic factors and chemical carcinogens, HPV should be considered as a possible cofactor in the etiology of keratoacanthoma.

Erfolgreiche Therapie des IgA-Pemphigus vom subkorneal pustulösen Typ

IgA pemphigus is a rare autoimmune intraepidermal blistering disease characterized by in vivo bound, and circulating IgA autoantibodies that target cell surface components (cadherins) of epidermal keratinocytes. The average age of onset is approximately 50 years. Histological hallmarks of IgA pemphigus are epidermal acantholysis, subcorneal or intraepidermal pustulosis, and neutrophilic infiltration. The main clinical characteristics are erythematous skin lesions with vesiculopustules, erosions, crusts and desquamation, favoring the trunk, groins, auxiliaries, and proximal extremities. The drug of choice for treating IgA pemphigus is diaminodiphenylsulfone. In this case study, we describe a patient who suffered from IgA pemphigus and responded well to diaminodiphenylsulfone.